Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT-1339 | WY |
N | 2251G0304X | Physical Therapist - Geriatrics | PT-1339 | WY |
N | 2251N0400X | Physical Therapist - Neurology | PT-1339 | WY |
N | 2251X0800X | Physical Therapist - Orthopedic | PT-1339 | WY |
NPI | 1710317797 |
---|---|
Provider Name | Jalyn M Anderson |
First Address | Laramie, WY 82070-5431 |
Second Address | Cheyenne, WY 82001-2162 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/11/2013 |
Last Update Date | 12/11/2013 |